Editor’s Note: This and other conditions associated with hepatitis C-in addition to the liver-related consequences of HCV disease progression- should be reason enough to treat everyone with hepatitis regardless of stage of liver disease – AF

In addition to increasing the risk of hepatocellular carcinoma, researchers have found that hepatitis C virus infection is associated with an elevated risk for developing bile duct cancers and diffuse large B-cell lymphoma among US older persons, a study published in the journal Cancer has shown.1

Although previous research has established that hepatitis C virus infection causes hepatocellular carcinoma and subtypes of non-Hodgkin lymphoma, its associations with other malignancies is unknown.

To evaluate associations between hepatitis C virus infection and other cancers in the US older population, investigators analyzed Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 1,623,538 adult patients aged 66 years or older who had their first cancer identified in SEER registries between 1993 and 2011 and from 200,000 cancer-free matched controls.

Out-of-pocket expenditures are thought to be a significant barrier to receiving cancer preventive services, especially for individuals of lower socioeconomic status. A new study looks at how the Affordable Care Act (ACA), which eliminated such out-of-pocket expenditures, has affected the use of mammography and colonoscopy. Published early online in CANCER, a peer-reviewed journal of the American Cancer Society, the study found that use of mammography, but not colonoscopy, increased after the ACA.

To determine changes in the use of mammography and colonoscopy among fee-for-service Medicare beneficiaries before and after the ACA’s implementation, Gregory Cooper, MD, of University Hospitals Cleveland Medical Center and the Case Comprehensive Cancer Center, and his colleagues examined Medicare claims data, identifying women ≥70 years old without mammography in the previous two years and men and women ≥70 years old at increased risk for colorectal cancer without colonoscopy in the past five years. The team also identified which patients were screened in the two-year period prior to the ACA’s implementation (2009-2010) and after its implementation (2011-September 2012).

Following elimination of out-of-pocket expenses for recommended cancer screening under the ACA, uptake of mammography increased in all economic subgroups, including the poorest individuals. On the other hand, preexisting disparities based on socioeconomic status in colonoscopy did not change. The investigators suspect that this may be due to other barriers related to colonoscopy, such as the need for bowel preparation or a loophole where a subset of colonoscopies still require out-of-pocket expenses.

“Although the future of the ACA is now questioned, the findings do support, at least for mammography, that elimination of financial barriers is associated with improvement in cancer screening,” said Dr. Cooper. “The findings have implications for other efforts to provide services to traditionally underserved patients, including the use of Medicaid expansion.”

At this point, it is not known which, if any, of the ACA provisions will be continued under the new administration. Representative Tom Price, the nominee for Head of the Department of Health and Human Services, has previously drafted a bill, Empowering Patients First Act, that outlines proposed changes in health care; however, details of specific requirements for both private and government-funded insurance programs are not given, including coverage for recommended preventive services.

NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER News Room upon online publication.

About the Journal

CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer.CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online athttp://wileyonlinelibrary.com/journal/cancer.

About Wiley
Wiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company’s website can be accessed at www.wiley.com.

AASLD 2016 – The Liver Conference

There have been reports of possible reactivation of HCV in cancer patients receiving chemotherapy. Up until now, the data are from retrospective studies. This prospective study enrolled 91 HCV-infected cancer patients. Those with liver cancer were excluded. The study looked for signs of HCV reactivation defined as an increase in HCV RNA ≥1 log10IU/mL over baseline and a hepatitis flare defined as liver enzymes (ALT) to >170 IU/ml.

Conclusion: Among those receiving cancer treatments, HCV reactivation occurred in 21% of patients, but only half of them (9 total) had a hepatitis flare. None had liver failure. The researchers concluded that most cancer treatments are safe in HCV+ pts, but advised monitoring those receiving rituximab or high-dose steroids.

Editorial Comments: I have two problems with this study. First, I think the study would have been better if they enrolled cancer patients who were cured of hep C. Second, I wish the study had been blinded. Chemotherapy and steroids can cause an increase in ALT levels, and comparing HCV-negative cancer patients to HCV-positive cancer patients seems like good science.

Lucinda K. Porter, RN, is a long-time contributor to the HCV Advocate and author of “Free from Hepatitis C” and “Hepatitis C One Step at a Time.” She blogs at www.LucindaPorterRN.com and HepMag.com

AASLD 2016

There were 13,315 patients identified with HCV and 38,991 patients without HCV who met the inclusion criteria. The people with HCV were more likely to be male, white, and have Medicare Advantage plans compared to the people who were HCV-negative. The average follow-up was 1.4 years for the group with hepatitis C and 1.5 years for the group without hepatitis C.

Conclusion: The people who were HCV positive were more likely to have diabetes, chronic pulmonary disease (lung disease), congestive heart disease, liver disease, renal (kidney) disease, AIDS and hepatitis B. Additionally, there was also an association between hepatitis C and liver and non-liver cancers (especially lung, pancreas and non-Hodgkin’s lymphoma),

The authors noted that their study supports previous studies that have shown that there is an association between cancers and chronic hepatitis C infection.

Editorial Comments: It is well known that hepatitis C infection increases the risk of other diseases including certain types of cancers. This study should reinforce that 1). We need to increase the number of people we test for hepatitis C and provide supportive and medical services 2). We should be monitoring people with hepatitis C for other conditions especially cancers, and 3). We should treat and cure hepatitis C as soon as people are diagnosed to prevent the beginning and the progression of various illnesses including cancers.

We know that chronic hepatitis C infection is not just a liver disease—it affects just about every organ in the body.

People who are cured of hepatitis C after a course of direct-acting antiviral (DAA) treatment do not have a higher risk of developing liver cancer (hepatocellular carcinoma), and probably have a reduced risk, studies from Italy and Canada presented at the 2016 AASLD Liver Meeting this week in Boston have shown.

However, Italian researchers also found that those people who did develop liver cancer during or shortly after antiviral treatment were more likely to develop an aggressive form of liver cancer, perhaps because of changes in immune surveillance in the liver as a result of treatment.

Hepatitis C infection can be cured with a course of DAA treatment, but eliminating the infection may not heal the liver sufficiently to prevent the development of liver cancer. Furthermore, there is evidence that people with cirrhosis previously treated for liver cancer have a high rate of recurrence of liver cancer. Two studies, conducted in Italy and Spain, both found that around 30% of people previously treated for liver cancer experienced a recurrence of liver cancer within a median of six months of completing hepatitis C treatment. Both research groups considered the rate of recurrence in their patients to be unusual and warned doctors to be on the lookout for liver cancer recurrence.

AASLD 2016

There were 13,315 patients identified with HCV and 38,991 patients without HCV who met the inclusion criteria. The people with HCV were more likely to be male, white, and more likely to have Medicare Advantage plans compared to the people who were HCV-negative. The people who were HCV positive were more likely to have diabetes, chronic pulmonary disease (lung disease), congestive heart disease, liver disease, renal (kidney) disease, AIDS and hepatitis B. Additionally, there was also an association between hepatitis C and liver and non-liver cancers (especially lung, pancreas and non-Hodgkin’s lymphoma), The average follow-up was 1.4 years for the group with hepatitis C and 1.5 years for the group without hepatitis C.

The authors noted that their study supports previous studies that have shown that there is an association between cancers and chronic hepatitis C infection.

Editorial Comments: It is well known that hepatitis C infection increases the risk of other diseases including certain types of cancers. This study should reinforce that 1). We need to dramatically increase the number of people we test for hepatitis C and provide supportive and medical services 2). We should be monitoring people with hepatitis C for other conditions especially cancers, and 3). We should treat and cure hepatitis C as soon as people are diagnosed.

We know that hepatitis C is not just a liver disease—it affects every area of the body.

The study is aimed at assessing the safety and immunogenicity of HCV prime-boost vaccinations ChAd3-hliNSmut and MVA-hliNSmut, administered intramuscularly in healthy volunteers and DAA treated patients. To read the entire study, click here Share This PageFollow Us … Continue reading → The post The study is aimed at assessing the safety and immunogenicity of HCV […]

The purpose of this study is to evaluate the efficacy and tolerability of DAA-based regimens in the clinical practice in HIV/HCV-coinfected patients. Hypothesis: The efficacy and tolerability of all DAA-based regimens in the clinical practice is different to what is … Continue reading → The post Real-life Security and Efficacy of DAA-based Therapy in 1,000 […]